BLOG No. THIRTY SEVEN

Welcome back to my blog on anxiety and depression. Today, I want to pick up on where I left off regarding anorexia nervosa and bulimia. In my previous blog I spoke about the two being similar, with bulimia being a more aggressive form, to the point is that the patient’s warped sense of body image drives them to binge eat and then purge—either north or south.

I also discussed the fact that these patients see their bodies differently than others see them, which reminded all my readers about depersonalization—which made me wonder about D2 dopamine.

And then, the obsessions over food—actually arguing over how many green beans they’re willing to consume, or how many calories they going to eat…doesn’t that sound like obsessive-compulsive disorder? Remember the case PANDAS in blog 24? The OCD caused by multiple strep infections?

Of course they are very much alike. So if you add the OCD of food to the depersonalization of body shape, I believe you get anorexia nervosa and bulimia. And as previously mentioned, anorexia nervosa is the number one psychiatric condition that leads to death. But just for a moment, let’s look at how anorexia causes patients to die. But since this is a bit heavy, let’s try joke break.

Three vampires walk into a bar. The first one says, “I would like a pint of blood.” The second vampire says, “I will have the same.” The third vampire says,” I just want a pint of plasma.”

So the bartender looks back at them and says, “So that’s two bloods and one blood light?”

So, anorexia nervosa and bulimia to do most of their damage with muscle loss. This is due to minimal protein ingestion, and muscles of course are made of protein. And unfortunately, cardiac muscle fade faster than skeletal (body) muscle. So the heart weakens as it loses muscle. And like other conditions with weak hearts, it generally jumps into a deadly rhythm.

Also, bones weaken and easily break, while white cells drop, leaving patients vulnerable to infections. Additionally, bulimia patients vomit so often, their esophagus becomes raw and perforate, leading to rapid death.

So, how do we treat anorexia nervosa and bulimia?

According to current literature, Prozac seems to be today’s go-to drug. And the loud scream I just heard was either my wife crossing paths with a spider, or all my readers shrieking in unison. Although olanzapine is occasionally added for help with weight gain, it is seldom added at the right dose to control D2 dopamine. And what do you think an anorexia nervosa or bulimia patient is going to do when they look up olanzapine on the Internet and see “weight gain”? Oh please, give me two! Yep, they are going to stop taking it.

So what do you think, loyal and informed readers? Yeah, that’s what I’m thinking too… a little Lamictal or Trileptal. You do not need to force weight gain on on anorexic. In fact it’s a stupid idea. You treat the underlying cause, elevated D2 dopamine, and the OCD and the depersonalization go bye-bye. What a concept? Actually treating the underlying cause! Who knew?

Well I was too lazy to go down to the wine cellar for Chardonnay, so I’m drinking an elegant Pinot Noir as I write. I bet you have Pinot envy right now! So until next time, when we talk about a case study on anorexia nervosa and bulimia, this is Dr. G saying keep the faith!